Reasons for home care clients’ unplanned Hospital admissions and their associations with patient characteristics

Abstract

BackgroundUnplanned hospitalizations and emergency room visits occur frequently among home care clients The aim of this study was to identify typical discharge diagnoses and their associations with patient characteristics among a total of 6812 Finnish home care clients aged ≥63 years who were hospitalized within one year of their first home care assessment. MethodsA register-based study based on Resident Assessment Instrument-Home Care (RAI−HC) assessments and nationwide hospital discharge records. The RAI−HC assessments were linked to the hospital discharge records of the participants’ first unplanned hospitalization. Univariate and multivariable regression analyses were used to evaluate the association of RAI−HC determinants with discharge diagnoses. ResultsThe most common reason for the first hospitalization was an infectious disease (21%; n = 1446). When hospitalizations were classified according to the main diagnosis, chronic skin ulcers, functional impairment and daily urinary incontinence were associated with hospitalization due to infectious diseases; impaired cognitive capacity, Alzheimer’s disease or other dementia and polypharmacy (protective effect) were associated with hospitalizations due to dementia; age of ≥90 years, congestive heart failure, coronary artery disease and using ≥10 drugs with hospitalizations due to heart diseases; and moderate or strong pain with hospitalization due to musculoskeletal disorders. Previous falls, female sex and an earlier hip fracture were associated with injury-related hospitalizations. Feelings of loneliness increased the odds of hospitalization due to geriatric symptoms without a specific diagnosis. ConclusionPatient characteristics and geriatric syndromes identified using RAI−HC predict the reasons for future hospitalizations among new home care clients.